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Time to switch?


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#1 stpaddy

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Posted 01 December 2017 - 06:18 PM

My husband's PCR is normally tested every 3 months but due to an administrative mix-up, it was tested twice in October.  (Two separate blood samples were taken, 15 days apart.  The second one was supposed to be a CBC but PCR ended up being tested).  The results are below.

 

His next PCR is in January so for now we are waiting to see those results.

 

Onc says to consider a switch to Sprycel if levels in January are up from Oct 18.  I suppose the other option is to go back to 400mg Gleevec instead of the current 300mg.

 

Not sure which way to go if the PCR is up in January.

 

We are also wondering, can you go back to Gleevec once you switch to Sprycel?

 

Thank you!


Husband dx March 2016; 400mg Gleevec started April 2016;

July 2016 PCR 3.06% 

Oct 2016 PCR 0.002%

Jan 2017 PCR 0.004%

April 4, 2017 PCR 0.001%

Reduced to 300mg Gleevec at end of April 2017 due to fatigue   

July 2017 PCR 0.001%

Oct 3, 2017 PCR 0.001%

Oct 18, 2017 PCR 0.003%

Dec 19, 2017 PCR 0.001%


#2 kat73

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Posted 01 December 2017 - 06:47 PM

Wow, these are terrific numbers!  You don't have to do a thing.  He absolutely has zoomed - he got to DMR (<0.01% IS) in 6 months!  The last six PCR's are not significantly different - they reflect only lab noise.  Not only does he have ONE zero to the right of the decimal point, he has TWO - he is doing very, very well.  If he can tolerate 300 mg Gleevec, he is likely to see a further drop to undetectable in the future.  I see absolutely no reason to switch drugs unless he wants to - the side effects profile is different for Sprycel and might suit him better.  But in terms of how he's doing, it almost couldn't be improved upon.  People go YEARS before they see numbers like those.

 

Yes, if you have not switched because a drug has stopped working, then you can always go back to it. 


Dx July 2009 on routine physical.  WBC 94.  Started Gleevec 400 mg Sept 2009.  MMR at 2yrs.  Side effects (malaise, depression/anxiety, fatigue, nausea, periorbital edema) never improved.  Kidney issues developed because of Gleevec.  Switched to Sprycel 70 mg in Aug 2011.  Above side effects disappeared or improved.  Have been MR3.5 - 4.5 ever since.  Two untreated pleural effusions followed by one treated by stopping Sprycel Jan 2017.  After 9 weeks, PCR showed loss of MMR; re-started Sprycel at 50 mg and in 3 months was back to <0.01% IS.  Pleural effusion returned within a couple of months, same as before (moderate, left side only).  Stopped Sprycel 50 mg for 12 weeks; pleural effusion resolved.  At about a monthoff the drug, PCR was 0.03; at 11 weeks it was 2.06 - lost CCyR? Have returned to 50 mg Sprycel for 3 weeks, intending to reduce to 20 mg going forward.


#3 stpaddy

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Posted 03 December 2017 - 05:04 PM

Thanks for your reply kat73!


Husband dx March 2016; 400mg Gleevec started April 2016;

July 2016 PCR 3.06% 

Oct 2016 PCR 0.002%

Jan 2017 PCR 0.004%

April 4, 2017 PCR 0.001%

Reduced to 300mg Gleevec at end of April 2017 due to fatigue   

July 2017 PCR 0.001%

Oct 3, 2017 PCR 0.001%

Oct 18, 2017 PCR 0.003%

Dec 19, 2017 PCR 0.001%


#4 CallMeLucky

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Posted 05 December 2017 - 10:45 AM

Those two results in Oct are the same.  If anyone tells you the difference between .001 and .003 are cause for concern, run away and find someone else.  This just shows that PCRs are inconsistent.  If next result shows a continued upward trend (decimal point movement to the right) then more attention may be needed, otherwise this is just noise in the test.


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 





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